To the Editor
It is interesting that 50% of the participants at a recent renowned anesthesia society refresher course stated that they monitored patients in an MRI scanner from the scanner control room. This same issue was recently covered in the ASA Newsletter.
Although I have not given an anesthetic for a MRI in the last 9 years since I retired, I was the principal anesthesiologist doing MRIs at Washington University/Barnes Hospital for 8 years before that, and always monitored the patient from within the scanner itself. The other point is that I usually had the same CRNA working with me, and we both stayed inside the scanner. I am a firm believer in a team approach here.
When we started working with the MRI technicians we were cognizant of their needs, and attempted to help them with a difficult problem when they needed to perform magnetic imaging on a patient who could not remain immobile for the time of the exam. We first started with children and progressed to adults. The MRI technicians were also very helpful to us, and soon allowed us to bring our equipment, although not specialized, into the scanner and showed us where we could safely place the equipment. Recognizing the limitations of the scanner is most important for non-MRI personnel. Having personnel who are accustomed to working inside a scanner is critical.
We learned key lessons about what was compatible with the scanner and what was not. I became the infusion pump when we found out that not every infusion pump works inside the scanner. One of the things to do is to set up a mock MRI scan and try the equipment out and make sure it works first. You should monitor everything inside the scanner just as you do in an OR.
We administered multiple anesthetics for pediatric radiation therapy, which share many of the same considerations, except that you cannot remain inside the generator room while the radiation is being administered, but we were behind the safety screen with a chest stethoscope on the patient’s chest plus all the other monitoring for the brief radiation time. If things are not going well with an individual case, do not be afraid to quit and come back another day. We even anesthetized a 34-year-old adult silverback gorilla for an MRI in a regular scanner the same way.
Personnel should not be concerned about the magnetic radiation affecting them as long as they take their credit cards out of their pocket. It has not affected my 21-year-old total hip replacements either. The ASA cannot and should not relax its standard of having anesthesia personnel present in the room during the administration of anesthesia.
Bernard C. DeLeo, MD
Sun City Center, FL